Alaska Natives continue to experience high stroke mortality despite a drop in stroke mortality in the general US population. The epidemiology of stroke has not been well studied in Alaska Natives. Building on a thirty-year experience with chronic disease registries at the Alaska Native Medical Center, an Alaska Native Stroke Registry is proposed to support the study of this disparity in mortality, and improve management and care of stroke patients. Drawing on the extensive computerized database in the Resource and Patient Management System for Alaska Natives, patients with stroke will be identified and tracked. Overseeing the registry will be a group of neurologists and epidemiologists with experience in managing stroke and in the development and management chronic disease registries. The proposed project will be conducted in two phases. Phase I, lasting two years, will be a pilot phase to develop and implement a model stroke registry targeting Yupik Eskimos living in the Yukon-Kuskokwim Delta and Bristol Bay service units. The goals of Phase I will be to develop registry infrastructure and data gathering methods to better define the epidemiology of stroke among Alaska Natives. Phase II, also lasting two years, will expand the registry statewide. The goals of Phase II will be to identify strategies to reduce risk factors and to improve evaluation and care of patients with stroke statewide. Other goals of Phase II will be to describe the incidence, prevalence and mortality of stroke in this population. This registry will serve as an important tool in efforts to improve the quality of stroke care in Alaska Natives, to monitor stroke incidence, track trends, reduce incidence, and improve the outcome of stroke in this population.